EDS to triage Medicare claims in Northeast states

EDS Corp. will help the Centers for Medicare and Medicaid Services administer claims payments in the Northeast under a five-year contract that could be worth as much as $176 million.

The contract will help CMS fulfill the contracting requirements of the 2003 Medicare Modernization Act, which requires the agency to transition Medicare fee-for-service claims from fiscal intermediaries and carriers to Medicare Administrative Contractors, EDS officials said.

Under the CMS award, EDS’ subsidiary NHIC Corp. will administer Part A and Part B Medicare claims payments for health care providers in five northeastern states.

The Medicare Administrative Contractor contract will help streamline Part A and Part B Medicare claims processing in Maine, Massachusetts, New Hampshire, Rhode Island and Vermont, the officials said. The Jurisdiction 14 contract will serve approximately 1.7 million Medicare fee-for-service beneficiaries, almost 80,000 physicians and practitioners, and 220 Medicare hospitals in the five states, they added.

NHIC will assume full responsibility for the claims processing work currently performed by three fiscal intermediaries and two carriers. The company also will serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians and other health care providers within the jurisdiction.

NHIC also will administer Medicare claims filed by home health and hospice providers in the five states and Connecticut. It also will provide education and information regarding the transition to Medicare providers, host webinars and conference calls, and provide a toll-free hot line to support various transition activities.

NHIC supports CMS in 11 Northeastern states and the District of Columbia, and it administers Medicare Part B claim payments as a Medicare contractor in New England.

EDS, of Plano, Texas, ranks No. 10 on Washington Technology’s 2008 Top 100 list of the largest federal government prime contractors.